Standing Committee A

[MISS ANN WIDDECOMBE in the Chair]

NHS Reform and Health Care Professions Bill

Clause 23 - the council for the regulation of health care professionals

Ann Widdecombe: I understand that the Opposition want a stand part debate on clause 23, so I ask the Committee—indeed, I insist—that the three groups of amendments be debated according to the narrow way in which they have been drawn.

Oliver Heald: I beg to move amendment No. 224, in page 28, line 31, leave out from 'bodies' to end of line 33.
 This is a probing amendment concerned with the functions of the Council for the Regulation of Health Care Professionals as described in clause 23(2)(d). Under the clause, the council will promote co-operation between the eight regulatory bodies to which it refers, and I am happy for that principle to be extended to the further body that the Minister is seeking to add to the list through a later amendment. However, if the amendment were accepted the council would not promote wider 
''co-operation between regulatory bodies; and between them, or any of them, and other bodies performing corresponding functions.''
 It is worth bearing in mind that some of the bodies listed in subsection (3) contain more than one profession. For example, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting contains three professions, and the Council for Professions Supplementary to Medicine contains 12. In total, clause 23(3) lists about 20 bodies that will have a duty to work together, and between which the council will have a duty to promote co-operation. 
 Why is it necessary for a wider group of bodies to co-operate with such health bodies? If subsection (3) listed just one or two bodies, it might be reasonable to argue that such co-operation is necessary to ensure that matters are dealt with consistently across a range of professions. However, subsection (3) lists some 20 bodies, so why is it necessary to expand the list yet further? Moreover, what sort of bodies does the Minister have in mind? Although the Department of Health is responsible for the Bill's progress, I believe that the bodies listed in subsection (3) are the responsibility of the Privy Council Office. Bodies such as chartered institutes and bankers are also the responsibility of the Privy Council Office. With that in mind, what would be the point of trying to promote co-operation with, say, architects? 
 Will the professional regulatory bodies that we are discussing be required to co-operate with, and promote co-operation between, bodies that embrace a wide range of professions? I believe that a UK professional council exists that covers such a range. Will the Minister flesh out what he has in mind in terms of promoting co-operation? Will he also confirm that there is some point to the provision, and that it is not just a bureaucratic exercise involving people spending a lot of time discussing parameters and broad agreements to little effect?

John Hutton: I am grateful to the hon. Member for North-East Hertfordshire (Mr. Heald) for giving me the opportunity to explain the matters that he raised.
 We do not envisage the UK council having any role in relation to the qualification of architects, bankers and chartered accountants. It is a council for the regulation of health care professionals, and all its functions must be seen and exercised in that context. The bodies with which it should be able to discuss matters are the quality standard-setting bodies that have an impact on the delivery of health care and health care services, not those that deal with bankers, architects or accountants. Those are all worthy professions, and I have nothing against them, but they will not fall within the remit of the council. The Bill has been constructed to ensure that that does not happen. 
 The hon. Gentleman asked why we wanted the council to have a wider remit. In essence, the answer lies in the Kennedy report. Professor Kennedy saw it as part of the council's rationale that it should be able to work closely with other quality-related bodies. As I understand it, that is the reasoning behind new clause 2, which we will debate later. 
 The amendment would make it harder for the council to promote co-operation between, for example, a regulatory body and the Quality Assurance Agency for Higher Education about the fitness of purpose of educational courses and qualifications in relation to health care professionals. It would make it harder for the General Medical Council and the specialist training authority or the joint committee on the post-graduate training of GPs or its planned successor, the medical education standards body, to have discussions and closer co-operation on the admission of doctors to the specialist register. It would make it harder for there to be discussions between the regulatory bodies and the General Social Care Council, or between the GMC, the General Dental Council and the national clinical assessment authority about the thresholds at which poor performance by a doctor or dentist could lead to referral to their regulatory body. 
 We regard this provision, as did Professor Kennedy, as a necessary adjunct to the proper discharge by the council of its new functions. It is not designed to extend its remit into professions that have nothing directly to do with health care professionals and their regulatory and educational requirements. As Professor Kennedy said, the overarching body that is established by clause 23 needs to have a broad co-ordinating function between the regulatory bodies and the bodies that are responsible for setting quality standards on education and training in relation to the relevant professional organisations. 
 This is not a back-door route to bringing within the remit of the council a whole range of professional organisations that have nothing to do with the regulation of health care professionals. It is a sensible measure that will ensure, as Professor Kennedy argued, that the council can do its job properly.

Oliver Heald: Just so that we are clear about this, is the Minister ruling out the promotion of co-operation with regulatory bodies for architects, bankers and so on, and limiting it purely to the health context?

John Hutton: Yes, that is my understanding of the Bill.

Simon Burns: As my hon. Friend the Member for North-East Hertfordshire said, this is a probing amendment, and I want to probe the Minister a little further.
 Subsection (2) lays down the general functions of the council, which include: 
''to promote the interests of patients and other members of the public . . . to promote best practice in the performance of those functions . . . to formulate principles relating to good professional self-regulation . . . to promote co-operation between regulatory bodies''.
 Those are all eminently sensible. However, given the importance of education, professional development and training, to which the Minister referred, why does the Bill include nothing specific about them in relation to the functions of the council? I am sure that the Minister would agree that all three of those areas are critically important, and unless there were good reasons to the contrary, they should be included in the functions under subsection (2).

John Hutton: As I understand it, the hon. for West Chelmsford (Mr. Burns) is arguing for the UK council to have some jurisdiction in relation to setting educational training standards for a variety of health care professions. It is an interesting argument, but I do not think that we want the UK council to discharge that role. We may come to this discussion when we look at some of the amendments about the composition of the council.
 As we envisage it, the body will have a lay majority, and some perfectly reasonable concerns would be expressed about a body with a lay majority setting professional standards for doctors' qualifications and so on, and that would not be a sensible path to go down. I know that the amendments would equalise the balance, but even then I am not sure that that would be a sensible thing to do. Existing bodies have responsibilities in these areas, including the royal colleges. We intend to establish, I hope later next year, the medical education standards board to provide oversight and an overview of the work done by the Special Training Authority and the joint committee in relation to the education and training of GPs. It is important that they are professionally-led responsibilities. We certainly envisage that continuing in the future. 
 The UK council's role is different. We are setting it up partly in response to what Professor Kennedy said, and the reasoning in his report, which I am sure we will come to in the debate on stand part. We are also setting it up for reasons that we set out in the NHS plan last year. In both cases, certainly in the NHS plan, we tried to explain why we wanted to set up a council and why professional education training issues should be dealt with elsewhere. 
 The hon. Gentleman has an interesting point to make, but, in relation to some of the points that I have tried to address, it is better for the educational issues to be dealt with elsewhere, within professionally-led organisations, rather than within an organisation with a lay majority.

Oliver Heald: Having heard the Minister give a clear assurance that the promotion and co-operation is between regulatory bodies and other bodies within the health sphere, I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

John Hutton: I beg to move amendment No. 198, in page 28, line 41, at end insert—
'( ) subject to section 24(5A), the Pharmaceutical Society of Northern Ireland,'.

Ann Widdecombe: With this it will be convenient to take Government amendments Nos. 199, 201 and 202.

John Hutton: The first amendment seeks to add the Pharmaceutical Society of Northern Ireland to the list of bodies within the scope of the Council for the Regulation of Health Care Professions. The second and third amendments together make the same provision for the hybrid status of the Pharmaceutical Society of Northern Ireland, as both a regulator and a professional body—as we have already made in clause 24(5) in relation to the Royal Pharmaceutical Society of Great Britain. The fourth amendment brings the Pharmaceutical Society of Northern Ireland within the scope of clause 27, which relates to the council's power of public interest appeals.
 Essentially, the amendments are necessary to reflect the separate ways in which the pharmaceutical profession is regulated across Great Britain and Northern Ireland. 
 Part 2 of the Bill applies to Northern Ireland as each of the regulatory bodies covers the whole of the UK. In the case of pharmacy, there is a Royal Pharmaceutical Society of Great Britain and a separate Pharmaceutical Society of Northern Ireland. Therefore, in order to apply the Bill properly to pharmacy in Northern Ireland, there needs to be a reference to the Pharmaceutical Society of Northern Ireland wherever the Royal Pharmaceutical Society of Great Britain is mentioned. 
 As members of the Committee will probably be aware, the regulation of health care professions in Northern Ireland is a matter transferred to the Assembly under the terms of the Northern Ireland Act 1998. That means that the Bill can apply to Northern Ireland only with the consent of the devolved authorities there. However, we have secured that consent and the Northern Ireland executive is happy for us to proceed along the same lines as we are in England, Wales and Scotland. 
 Amendment No. 198 is self-explanatory and would add the Pharmaceutical Society of Northern Ireland to the list of bodies included in the council. As with the Royal Pharmaceutical Society, the PSNI is distinct from the other regulatory bodies covered by the council in that it is both a regulatory body and a professional organisation. The Bill reflects that unusual status for the RPS and amendments Nos. 199 and 201 simply mirror the provisions in relation to the Pharmaceutical Society for Northern Ireland. 
 Amendment No. 202 adds the PSNI's fitness to practice decisions to the list of decisions against which the council may appeal in the public interest under clause 27.

Oliver Heald: I welcome the amendments. The Royal Pharmaceutical Society of Great Britain contacted me to explain that its remit does not extend to Northern Ireland, which has its own pharmaceutical society, and that clarification is needed about inclusion of the sister body in Northern Ireland into the new structures. I am sure that it will also welcome the amendment.

John Hutton: I am grateful for the hon. Gentleman's support.
 Amendment agreed to

Oliver Heald: I beg to move amendment No. 225, in page 29, line 15, after 'sections', insert
'save that the reference to the provision of general dental services in subparagraph 2(d) of paragraph 11(2) of Schedule 3 of the 1999 Act includes the performance of personal dental services,'.
 This is a probing amendment to establish whether regulation of the qualifications or experience required to provide general dental services, as set out in paragraph 11(2)(d) of schedule 3 to the Health Act 1999, also covers personal dental services or, if not, whether that is covered in some other way in the Bill. 
 Clause 23(6) states: 
''In this group of sections, references to regulation, in relation to a profession, are to be construed in accordance with paragraph 11(2) and (3) of Schedule 3 to the 1999 Act.''
 Paragraph 11(2) of schedule 3 to the 1999 Act states: 
''References to regulation, in relation to a profession, in that section and this Schedule include . . . (d) in the case of the profession of dental practitioner, the regulation of the qualifications or experience required for a dental practitioner to provide, or assist in the provision of, general dental services under the 1977 Act.''
 We have dealt with personal dental services in various parts of the Bill and I seek the Minister's assurance.

John Hutton: Once again, I am grateful to the hon. Gentleman who has drawn attention to what he believes is a gap in the provisions as they apply to the council. His amendment would cause references to regulation in the provisions to be read as including the regulation of the qualifications and experience required for the performance of personal dental services. It may be helpful if I explain the background because he has made a fair point and I want to explain why there is no gap.
 The section 60 powers in the 1999 Act permit the creation, modification and amendment of legislation covering the regulation of health care professions to be carried out by order, subject to various limitations and procedural safeguards. We introduced those powers in that Act to make it simpler and more efficient to keep the relevant regulatory legislation up to date. Before the 1999 Act, there was always a problem finding legislative time on the Floor of the House to update and modify existing legislation, particularly against the background of a number of professional groups wanting their own new schemes of professional self-regulation. 
 This group of clauses uses the same definitions for the regulation of health professions set out in section 60 and schedule 3 of the 1999 Act. The schedule refers only to qualifications or experience required by a dental practitioner to provide, or assist in the provision of, general dental services. The amendment would include personal dental services in the scope of the UK council. The schedule relating to section 60 makes particular reference to personal medical services and so, as the hon. Gentleman said, there would appear to be an inconsistency. However, there is a difference between the regulation of qualifications or experience required for personal medical services and that required for personal dental services. 
 By virtue of primary legislation and European Union law, all doctors performing general medical services or personal medical services under a pilot must complete vocational training, which is period of employment after qualification during which the practicalities of general practice will be learned, including clinical learning, and learning about contractual matters. Dentists must also complete vocational training before becoming a principal on a health authority's list. To be able to perform personal dental services under a pilot scheme, there is no need to have completed that year of vocational training, although such a dentist would be fully qualified and required to work under supervision as part of personal dental services. 
 The hon. Gentleman's amendment is unnecessary because it does not recognise the distinction between the qualifications required to perform personal medical services and those needed to perform personal dental services. I hope that the hon. Gentleman feels reasonably reassured. Although there appears to be an inconsistency in the Bill, the differences can be explained in terms of the vocational and training qualifications required for a dentist to perform personal dental services.

Oliver Heald: That is helpful because it explains the apparent gap in provisions under paragraph 11(2) of schedule 3. I fully accept that the Minister's explanation deals with that, but I will think about it again before Report. I beg leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Question proposed that, That the clause, as amended, stand part of the Bill.

Oliver Heald: The setting up of the Council for the Regulation of Health Care Professionals is something that we are not minded to challenge directly by seeking to divide the Committee. However, we would like reassurance from the Minister that it is the correct approach.
 The background to the council is that the Kennedy report suggested that an overarching body should deal with the regulation of health care professionals and the various bodies described in clause 23. However, some are asking whether it is the best way forward. The fact that Professor Kennedy suggested that such a mechanism should exist is powerful evidence, but the General Medical Council, which is probably the body to have received the most publicity in this area and has been criticised in many high profile cases, has taken steps to amend its procedures and make changes. The GMC's ability to regulate the profession has arguably changed since the Kennedy report. 
 For example, the new interim orders committee has been effected and further initiatives amount to a radical constitutional change in the GMC. The Minister will recognise measures such as periodic revalidation for all registered doctors and we welcome further changes to the fitness to practice procedures. The Medical Protection Society is an important body that provides indemnity, particularly for general practitioners, and it has made it clear that it is supportive of the changes that the GMC is making—we all are, in broad terms. The MPS states: 
''A new Council for the Regulation of Health Care Professionals will add a further layer of bureaucracy which, in our submission, is likely to prove superfluous. A better way of improving accountability of the GMC would be to make it directly accountable to Parliament through the Health Select Committee. The proposed Council with powers to the extent set out in the Bill effectively brings to an end the concept of self-regulation. Individual regulatory bodies may be forced to make changes which they consider inappropriate for their own profession. If the Council is to be established, it should be advisory only, with no powers to require or impose change on individual regulators. The concept of an integrated approach is misconceived given the different clinical and professional responsibilities and working environments of each profession. Self-regulation may be imperfect, but is still the best means of regulating the professions. A body comprising doctors or dentists, together with lay representatives, is the ideal way of ensuring the rights of patients and practitioners are protected and the regulatory procedures are fair, transparent and efficient.''
 In a later new clause we shall examine whether there is a case for bringing together the four main regulatory and inspecting bodies that the Government have recently created. Would one way in which to deal with that without setting up another council be to build on the procedures that we have in this place by making the General Medical Council and other bodies directly accountable to the Select Committee on Health? That would boost Parliament and play into the current arguments in this place about the way in which our procedures could be developed to make the legislature stronger to provide a greater counterbalance to the Executive. 
 One criticism of the Government's proposals is that there is an area of weakness when it comes to the independence of the Council for the Regulation of Health Care Professionals. Many provisions will be made by the Secretary of State, although it is good that the Minister is accepting one amendment, who will be able to mould and fashion the Council for the Regulation of Health Care Professionals—his appointees; his direction; his council. It might be more inclusive if it were our job as parliamentarians to be the responsible body to which these various professional regulatory bodies report. 
 The responsibility falls under the remit of the Leader of the House, who is also the Lord President of the Council. The Privy Council Office is the administration that deals with regulatory bodies, and it is only because these are health bodies that the Department of Health is taking this part of the Bill through the House. The overall responsibility in government for such work rests with the Privy Council Office. A search for reform by the Leader of the House helps the legislature gain prominence and authority. This is his area of responsibility, and he is giving ground to the Secretary of State for Health. In short, Parliament is giving ground to the Executive. 
 I should be interested to hear the Minister fashion an argument for this further layer of bureaucracy. I am not saying that we shall seek to divide the Committee on the clause, but I should be interested to hear the Minister justify that. As I said to him when we were debating the order that dealt with the Health Professions Council, it is not enough simply to say that because Professor Kennedy thought that something was a good idea, therefore it is a good idea. The Government need to justify and fill out the argument.

Andrew Murrison: I should declare an interest, as I am a subscriber to the GMC, the main body being considered. That does not mean that I am necessarily arguing for it; quite the reverse. Having suffered over many years from an increasing subscription, I must say that the GMC, even now, sends shivers down my spine.
 The Government have some catching up to do. The GMC has done a great deal to put in place measures to prevent tragedies such as those that we have recently seen, especially in the light of the Kennedy report. We must not lose sight of the fact that much of what we are considering today would not have a material effect in preventing some of those tragedies. Some things that we discussed earlier in the Bill might do that, but I do not think that this will. 
 I believe that this part of the proposal is ill-conceived. It treats the various professional groups under discussion equally, when they are not equal numerically or in terms of their professional responsibility and accountability. That might be acceptable, but we need to bear it in mind. We should not assume that because the clause deals with the bodies equally, they are equal in numbers or responsibility. The professions allied to medicine are especially concerned with the proposal and the representation that they would have on the council, were the clause enacted. 
 We must recognise that the proposal would sound the death knell of self-regulation. It will give us an over-arching body, able to direct closely the functions of the professional bodies. That will have a knock-on effect on the ability to attract the best in the professions to take part. At the moment, I can speak only for the GMC because it is the body about which I know most, but there is a great deal of status in becoming a member of that organisation, and much competition to do so. It attracts some of the very best in the profession. I fear that, with the degrading that we are discussing today, it will be increasingly difficult to attract some of the top people from my profession—and, I suspect, from the other professions under consideration—to take part in the crucial matter of regulating. Regulating one another is important and sensitive, and needs the best minds in those professions. I fear that the quality of the bodies will be diminished by the proposals. 
 The cost of the council is rather opaque. The Minister must make clear whether the regulatory bodies themselves will fund it, or whether the money will be found centrally in some way. 
 The independence of the new body is very important. I am sure that we will hear much from hon. Members about their concerns that the body be independent of ministerial control. That will require some parity in ministerial and non-ministerial appointments. It is important for regulatory bodies to be accountable to Parliament, as is currently the case. The Bill does not seem to establish any proper lines of accountability. We need a little more clarity on the lines of accountability of the regulatory bodies and the council. 
 The council will be able to intervene at the conclusion of a case by referring it to the High Court if it feels that that is desirable for the protection of members of the public. That will be of real concern if the power is not used very sparingly indeed. It could quickly become the norm for cases to be appealed, in effect, to the High Court. That would diminish the responsibility of the GMC in particular. In this context, we are really talking about the GMC. Various other bodies that have written to me have been keen to point out that they hear only a very small number of cases of professional matters such as negligence. It is principally the medical profession that is in the firing line. 
 In the light of the Kennedy report's recommendations, one welcomes the measure. However, there appear to be many gaps and matters that require explanation, and I should be grateful if the Minister clarified the issues that I have highlighted.

Richard Taylor: I have two questions for the Minister, the first of which concerns health visitors. The national body and many local health visitors have expressed distress about the fact that their title is missing from the Nursing and Midwifery Council. Can the Minister advise me on how to convince health visitors that they are not being neglected and cut out? The second point concern chiropodists in the independent sector, who carry out well in excess of 50 per cent. of routine basic foot care. Given that only a single, state-registered representative will be on the council, what measures will be put in place to protect those chiropodists who provide a vital role in the independent sector?

Evan Harris: It is difficult to do anything other than welcome clause 23, which, in establishing the Council for the Regulation of Health Care Professionals, implements a recommendation of the Kennedy report, even though it was foreshadowed, under a different title, in the NHS plan. Liberal Democrats have always made it clear that we support mechanisms to improve quality, and the co-ordination of quality assurance is an important factor in that regard. In general, we support the thrust and the recommendations of the Kennedy report, but we must not lose our critical faculties. We must recognise that it is an important source of advice and contribution to the debate. It is appropriate to look at what the report said about the council, and to flag up some questions that the Government must answer in future discussions. Page 435 of the report sets out the recommendations' desired effects, including that central Government
''create independent mechanisms for regulating the quality of healthcare and the competence of healthcare professionals.''
 Will the Government confirm that that is indeed the purpose? If there are subsidiary purposes, they should be spelled out. Recommendation 39 of the report mentions the need for ''overarching organisations'', and states: 
''A Council for the Quality of Healthcare should be created''.
 However, the Bill does not establish one. Recommendation 39 also states: 
''A Council for the Regulation of Healthcare Professionals should be created to bring together those bodies which regulate healthcare professionals (including, for example, the General Medical Council . . . and the Nursing and Midwifery Council); in effect, this is the body currently referred to in 'The NHS Plan' as the Council of Healthcare Regulators. These overarching organisations''—
 the report is talking about quality organisations— 
''must ensure that there is an integrated and co-ordinated approach to setting standards, monitoring performance, and inspection and validation. Issues of overlap and of gaps between the various bodies must be addressed and resolved.''
 That is a clear and effective summary of what we believe the council should do. I hope that, in subsequent discussions, the Government will stick to those principles, or clarify the areas in which they wish to go further.

Oliver Heald: Paragraph 75 of the report, on page 349, states:
''An effective system . . . needs an independence from the professions and from government''.
 Does the hon. Gentleman agree that that is a very important point? [Interruption.] I was quoting from page 349, paragraph 75.

Evan Harris: I do not doubt the hon. Gentleman's source.

Ann Widdecombe: Order. We cannot have two hon. Members on their feet at the same time. Has the hon. Member for North-East Hertfordshire finished his intervention? It was a long one.

Oliver Heald: Yes.

Evan Harris: I accept that the hon. Gentleman was being helpful in giving me time to find the reference.
 Recommendation 72 of the Kennedy report is explicit: 
''The Council for the Regulation of Health Care Professionals should be established as a matter of priority.''
 I accept that the Government are establishing the body as a matter of urgency. Indeed, they are doing so before we have had their formal response to the Kennedy report, which means either that the Bill is an urgent response to the issue or that they are taking their time over their response to the report. The report continues: 
''It should have a statutory basis. It should report to Parliament. It should have a broadly-based membership, consisting of representatives of the bodies that regulate the various groups of healthcare professionals, of the NHS and of the general public.''
 In so far as the clause goes, we want to give it our full support. Of course, the clause refers to schedule 7, which concerns the balance of that body's membership. Nevertheless, the Government should be commended on the relative speed with which they have brought forward the proposal. They have sought to stick relatively closely to the Kennedy prescription, rather than their original prescription in the NHS plan, and we warmly welcome the clause.

John Hutton: I thank those hon. Members who support clause 23. The hon. Member for North-East Hertfordshire is concerned about some of the details, and I shall respond to his points in a moment.
 Out of all the hon. Members who spoke, the only one who indicated a lack of support was the hon. Member for Westbury (Dr. Murrison), and he prefaced his remarks by drawing attention to the fact that he is a member of the BMA.

Andrew Murrison: I subscribe to the GMC because I am obliged to; I am not a member of the BMA.

John Hutton: I understand that the hon. Gentleman feels that this is needless bureaucracy that would not advance the issues that we are trying to address. That is probably the minority view in relation to the proposals, which we sent out for consultation in the autumn.

Andrew Murrison: Just to clarify, the Minister is putting words into my mouth. I said that I broadly support the clause.

John Hutton: I am grateful to the hon. Gentleman for pointing that out. I missed that part of his remarks, but I am sure that he said that. However, the general tone of his remarks was less supportive than that of the other hon. Members who spoke in relation to the clause. We must address whether existing arrangements are satisfactory. In my view they are unsatisfactory, which is why we have brought forward these provisions.
 Turning to the remarks made by the hon. Member for North-East Hertfordshire, it is not the case that because Professor Kennedy recommended that we establish this council we simply accepted his recommendation. We have looked carefully at Professor Kennedy's arguments, which have been the subject of detailed quotation between the hon. Members for Oxford, West and Abingdon and for North-East Hertfordshire. I shall also be selectively quoting parts of the report in a moment. The arguments why a body with the powers that we are recommending should be established are carefully set out in Professor Kennedy's report. If we want to avoid the trap of establishing a pointless extra tier of bureaucracy, we must be clear that the council should have a range of reserve powers to use in certain situations. 
 It is to avoid the suggestion that this is a pointless tier of bureaucracy that we have brought forward these proposals. We do not want the council to become a talking shop, and it must fulfil a range of specific and valuable functions that will enhance the concept of professionally led self-regulation. Indeed, it must increase public support and confidence in the system of professional self-regulation. I would be the first to acknowledge that the professions have recently made significant steps forward in their approach to professionally led self-regulation, which is to be welcomed, but it does not subtract from the logic of Professor Kennedy's arguments. 
 He was mindful of those changes in preparing his report. We strongly support the Kennedy report's conclusions in that respect. I will return to those arguments in favour of the council in a second. 
 Several hon. Members spoke effectively about important principles that should underpin the work of the council, and I agree with them in general. The hon. Member for North-East Hertfordshire mentioned the need for independence from Government and I strongly agree with that. As he knows, we have been examining ways to strengthen and support further the independence that all Committee members, I think, want. We have tabled several amendments that are designed to do that, and we will come on to them later. We are at one with the hon. Gentleman on that matter, although we will have some difference of opinion about the details. That is to be expected, but I do not think that the principle separates the two sides of the Committee. 
 The hon. Gentleman also mentioned accountability and the role of Parliament. That is an interesting area. I should make it clear to the Committee that the UK council will not supersede existing lines of accountability for regulatory bodies. Those will remain in place. The council will be given an overarching responsibility for co-ordination and for promoting patients' and the public's interests in self-regulation. Those are important functions. The lines of accountability of the new UK council will be to Parliament, because it will be to Parliament that it submits its report. 
 The hon. Member for North-East Hertfordshire raised interesting arguments about how that accountability would be expressed in terms of the arrangements that we make in this place. Opposition Members will be glad to know that I am not about to legislate in that area. I do not think that that would be appropriate for Government. As the hon. Gentleman rightly said, such matters are for the House to consider, in the light of how the new council wants to discharge its responsibility of oversight.

Simon Burns: Is the Minister worried that the Secretary of State's power to appoint members of the council might compromise its independence?

John Hutton: Yes, and that is why we have tabled amendments to make it clear that the NHS Appointments Commission, a special health authority, will be responsible for making the appointments that relate to the Secretary of State's role. The devolved administrations will appoint their members directly, but they will be only three out of 10 lay members. The seven for England will be appointed independently, at arm's length from the Secretary of State. We have listened to the regulatory bodies' concerns about that, and agree with them that the last thing that we want to do is to place a question mark, right at the beginning, over the independence and accountability of the new UK council.
 Wherever possible, we must maximise consensus on the UK council's role. We are giving it important tasks to discharge on our behalf. I do not agree with the view that has been expressed that the UK council is something of a sideshow or irrelevance. It will have a central role in shaping and developing future regulatory arrangements in co-operation with the regulatory bodies themselves. The point about independence was well made but I thought that I had addressed it in terms of other amendments. Perhaps we can clarify those issues when we come to them. 
 On the role of Parliament, matters should be addressed by the House itself. It would not be appropriate for a Minister to tell the House: ''This is how I think that this responsibility should be discharged.'' Ultimately, it has nothing to do with me. My responsibility to the House relates to how I discharge my role as a Minister of State in the Department of Health. It is not to tell the House of Commons how it should organise its scrutiny of the work of the UK council. 
 The Select Committee on Health, which has been mentioned, already has the power, opportunity and right to ask the GMC and any regulatory bodies to give evidence before it. On occasion, it has invited the GMC to do precisely that. That Committee will be able to continue to develop those lines of accountability. It is right to say that opportunities need to be explored in relation to how the House discharges those responsibilities, but that cannot be done effectively in legislation. We are opening up the council to an accountability relationship with Parliament. That is important and, I hope, generally welcome. 
 The two issues raised by the hon. Member for Wyre Forest (Dr. Taylor) will largely be dealt with by the orders that establish the new regulatory arrangements, rather than by the Bill. The Bill simply ensures that if those orders were approved in another place, the new nursing and midwifery council and health professionals council will fall within the remit of the UK council. 
 The health visiting profession will be fully regulated by the nursing and midwifery council, so there is no question of it being spirited away from the jurisdiction and competence of the UK council. If the order establishing the nursing and midwifery council were not to be approved, health visiting would remain subject to full regulation by the UK Central Council for Nursing, Midwifery and Health Visiting. There is no question of any potential gap or loophole in that respect. 
 In relation to chiropody, the hon. Member for Wyre Forest argued for chiropodists to be directly represented on the UK council. However, it is not for Ministers to determine which members of the regulatory bodies can serve on the council, because the Bill stipulates that that should be decided by the regulatory bodies themselves. I should hope that that would be welcomed on both sides of the Committee in the spirit of encouraging professionally led self-regulation.

Andrew Murrison: The difficulty centres on the notion of having a representative from the group of professions allied to medicine, which covers a vast array of professions within the health care sector. Chiropodists are worried that they will not have a voice because, numerically, their membership is dwarfed by that of other groups. Physiotherapists—my wife is one, so I must be careful what I say—are so large in number that they will almost certainly dominate the group, and others may not get a look-in.

John Hutton: I understand the hon. Gentleman's argument, and we have designed amendments that try to address the issue. However, we must be clear about the underlying purpose of the proposals. Representatives of the regulatory bodies will be on the council not to represent professional interests, but the regulatory system to which their profession or group of professions is subject. As the Council for Professions Allied to Medicine regulates 12 separate professions, I assume that the hon. Gentleman would argue for one of each to be represented on the council.
Dr. Murrison indicated dissent.

John Hutton: He would not. To be fair to him, we are not in the business of trying to arrange for every professional group of health care workers to have a representative on the UK council. The point is to have representatives from each of the regulatory bodies who can draw on their experiences of regulation in their professional sectors.
 The Council for Professions Allied to Medicine currently includes 12 bodies and may include many more in future, depending on how the council discharges its responsibilities in advising Ministers about sectors that may introduce professional self-regulation, such as psychology, operating department practitioners, perfusionists and others in the queue of those who recognise its benefits. The logic behind the proposals is not to try to identify and represent on the council every separate professional group, but to ensure that it includes a representative from each of the regulatory bodies. I accept that that raises an issue in relation to the CPSM because it is the largest regulatory body representing health care workers in the NHS, and eventually, I am sure, the private sector. The matter requires further exploration, but we shall do so more fully at a later stage. 
 In relation to chiropody, it is difficult for me to give the assurance that the hon. Gentleman wants because that would cut across the spirit and the letter of the clause. We are not proposing a separate representative on the UK council from each professional group of health care workers. I hope that I have dealt with some of the hon. Gentleman's concerns. 
 Clause 23 will broadly do four things. First, it will establish the council. Secondly, it will give the council its functions, which are 
''(a) to promote the interests of patients and . . . the public in relation to the . . . ('regulatory bodies') . . . 
(b) to promote best practice . . . 
(c) to formulate principles relating to good professional self-regulation, and to encourage regulatory bodies to conform to them, and
(d) to promote co-operation between the regulatory bodies; and between them . . . and other bodies performing corresponding functions.''
 Thirdly, the clause specifies which bodies come within its remit; there should be no ambiguity about that. Finally, it will give effect to schedule 7. 
 The new council will strengthen public confidence in professional self-regulation by acting as an independent defender of patients' interests. It is important to make it clear that the council is not, and should never be seen as, a substitute for professionally led self-regulation. Our system of regulation will be enhanced by greater co-ordination, consistency and accountability, and that is what clause 23 seeks to provide. 
 The proposals take their cue from Professor Kennedy's report, which states: 
''The regulatory bodies, embracing . . . matters to do with safety, quality and standards as well as the competence of healthcare professionals, must themselves be co-ordinated and their efforts aligned by some overarching system.''
 As the Consumers Association and the National Consumers Council have said, the regulators' accountability needs to be clearer and more consistent. The GMC said that its accountability was largely implicit and that that was unsatisfactory. The clause will remedy that by requiring regulators to conform to principles of good regulation and providing for effective scrutiny where necessary. As well as greater accountability, the new council will promote greater consistency. Professor Kennedy was keen for that and strongly argued for it. In the report, he said: 
''Duplication must be reduced. Equally, holes in the system must be stopped. Only in this way will the fragmentation and lack of clarity about responsibility for regulating the quality of healthcare, which was such a feature of Bristol, be addressed.''
 The BMA also supports the creation of the council and have argued that it will give consistency of action across the professional regulatory bodies. 
 To sum up our intentions in the words of the Kennedy report, we believe that 
''regulation of the healthcare professions must be seen in the round and organised accordingly.''
 That is what clause 23 seeks to do. I am glad to say that regulatory bodies in general have given the new council their support. We are aware of some of their concerns, particularly on clause 25, but they have been generally supportive and have said that, as regulators of the health professions, they welcome steps to promote best practice and common principles in the interests of patients. They also said that they support the proposed function of the new council as set out in clause 23(2) and want to be held clearly to account for what they do.

Evan Harris: It would be inappropriate to seek a debate at this point because we will have one under clause 25. However, paragraph 23(2)(a), (b) and (d) includes the word ''promote''—that was presumably chosen for a purpose—as opposed to choosing the expression, ''seek to ensure''. Is that to make sure that clause does not appear to have a directional function, or is it taken from the Kennedy report, or another general framework with which it is consistent?

John Hutton: The wording in the 23(2)(a) is consistent with the recommendations of the Kennedy report. The council's powers of direction which appear under clause 25 are separate matters. The exercise of such powers and the circumstances in which they can be used are defined in clause 25. When I described why we have decided to establish the new council, I said that it is important that those interests that we have identified in 23(2)(a) are promoted because that is the purpose and rationale of an effective system of professional self-regulation. That paragraphs states:
''interests of patients and other member of the public''
 It is difficult to imagine any other set of underlying principles on which we could rest a system of professionally-led self-regulation.

Evan Harris: That is a helpful answer. Is the Minister's view that one can only adequately promote the interests of patients and other members of the public through this body with a non-professional majority, however slim? The corollary is that when there is a professional majority, there may be tension between the promotion of the interests of patients and other members of the public, and the promotion of the interests of the profession.

John Hutton: The hon. Gentleman tabled an amendment to explore these issues, but Kennedy was clear that the best people to represent the views of patients and the public are the patients and the public, not members of professional groups or regulatory bodies. There is an inescapable logic behind that argument and we shall return to the matter later this morning when we discuss another amendment tabled by the hon. Gentleman.
 I am grateful for the general support that Committee members have expressed for establishing the council. I understand fully that the regulatory bodies and Conservative Members are concerned about the way in which the council will discharge its functions and we shall debate that shortly. However, I am encouraged by the strength and support that has been expressed today for the principle behind the establishment of the council. 
 Question put and agreed to. 
 Clause 23, as amended, ordered to stand part of the Bill.

Schedule 7 - The Council for the Regulation of Health Care Professionals

Evan Harris: I beg to move amendment No. 255, in page 73, line 4, leave out 'regulatory body' and insert
'of the regulatory bodies referred to in section 23(3)(a) to (g)(i), and three members appointed by the regulatory body referred to in section 23(g)(ii) or the successor regulatory body (within the meaning of Schedule 3 to the 1999 Health Act) to the Council for Professions Supplementary to Medicine, the Health Professions Council, established by an Order in Council under section 60 of that Act.'.

Ann Widdecombe: With this it will be convenient to take the following amendments: No. 188, in page 73, line 6, after 'appointed', insert—
'on the recommendation of the NHS Appointments Commission.'.
 No. 189, in page 73, line 12, leave out 'one fewer than' and insert 'equal to'. 
 No. 256, in page 73, line 12, leave out 'one fewer', and insert 'one more'. 
 Government amendments Nos. 203 and 204, 
 Amendment No. 226, in page 73, line 25, at end insert— 
'(2) The power to make regulations in this paragraph shall be exercisable by statutory instrument. 
 (3) A statutory instrument containing regulations under this paragraph shall not be made unless a draft has been laid and approved by a resolution of each House of Parliament.'.
 Government amendments Nos. 205 and 187.

Evan Harris: This is a large group of amendments and, as is often the way, the schedules dealing with membership and appointment attract controversy. That is evident from the number of amendments, which is unfortunate because there are larger issues at stake. It is interesting that a number of Government amendments are included in this group, and they will be welcomed by Committee members from all parties.
 Amendment No. 255 raises the issue that was discussed on clause 23 stand part; the difficulty perceived by some, if not many, members of professions that are regulated by the Council for Professions Supplementary to Medicine, soon to be the Council for the Regulation of Health Care Professionals, that they are under-represented on the new council. It is important to understand what representation means. The Minister made it clear that he wanted, rightly, the new council to have representatives from the different councils who can describe the way in which they work and share best practice. The Minister may argue that the health care professions that are regulated by the Council for Professions Supplementary to Medicine are not so different that it would be impossible for issues that will be discussed at the new council to be adequately represented by a member of that council who happens to be a member of one of the 12, but not of the others. There is some logic in that and the way in which schedule 7 is drafted makes that easy. 
 The Minister may argue that apportioning members on a numeric basis opens a raft of separate issues—for example, that there are many more nurses than doctors, even in Oxfordshireand that we should have proportional representation. I am certainly not suggesting that, which should reassure hon. Members who have a vested interest in the status quo. Nevertheless, it is important to put the case for the amendment, if only to give the Government the opportunity to recognise that we are starting from the existing system of health care professional bodies and councils, rather than from where logic would have led us had we started from scratch. 
 It is remarkable that there will be a representative from the council that regulates chiropractors and a separate representative from the council that regulates osteopaths, which are important, but not necessarily more important than the 12 health care professions currently represented by the Council for Professions Supplementary to Medicine. Yet, there will only be one representative of the vast number and the wide range of professions currently regulated by the CPSM.

Oliver Heald: Is there not a concern that the proposed nursing and midwifery council will represent two very large professions and the health visitors too, although they are not mentioned in the title? Why should they not have three slots, because there are probably as many of them as there are of all the health professionals in the health professions council? How would you calibrate the system?

Evan Harris: The hon. Gentleman asks you, Miss Widdecombe, how you would calibrate it. I think that you would find it very difficult. I am seeking to accept some of the Government's arguments that representation on this new council cannot be according to health care profession. First, the new council would be large and unwieldy; and secondly, it would still not be proportionate to membership. Of course, I accept that. This is a probing amendment to find out where the Government want to go with regard to the future structure of these councils and whether they recognise that this is a consequence, albeit an unfortunate one, of the fact that one health care profession has a separate council, whereas another regulatory council covers a wide range of organisations.
 In an earlier debate the Minister implied that because the proposed council will represent the regulatory functions of the councils that look after all these professions, there is no reason that representation will be any different in its quality or its stress, whether it represents a physiotherapist, a clinical scientist or a podiatrist. Many of those covered by the CPSM have argued that there is a different culture in those professions and that regulation is effectively a compromise between them. That is why there has been such a strong call for uni-professional bodies dealing with education and training. 
 The Minister will have to accept that because of the structures and the constraints that we are under, something may well be lost and he may need to offer some reassurance that the council will be looking mainly at issues that are unlikely to be affected by the profession of the representative on it. Indeed, the Government might argue that some issues involving best practice will be so clear and obvious that they could be adequately represented by lay members nominated to the council from the regulated councils. I am not saying that an issue need to be simple so that lay members can understand—I hope that I am not misunderstood on that point—but that something that is core to the regulation does not require professional input. 
 Another question that this debate raises is that when new professions are brought in, they will be under some incentive to have their own council, rather than join the health professions council, as it is soon to be, because they feel that their professional interest, which is already diluted on the council—chiropodists certainly see it that way—will be further diluted on the new council. That may cause difficulty in the speed with which we would want to ensure that there is adequate protection of title, and therefore public protection by regulating the new professions. 
 Through this amendment, I want the Government to accept that there is no perfect way of doing this given the asymmetry of the current councils. The councils regulate issues such as education and training, which are different in the various professions in the CPSM, on which they take advice from professional advisory committees. Those professions should not be subject to direction or suggestion from the council without wider consultation with the health care professions. The specific issues associated with physiotherapy and chiropody are different from those associated with the clinical sciences. I hope that the Minister has understood my point. 
 If it meets the Committee's wishes, it may be appropriate to discuss the other amendments. I have appended my name to amendment No. 188, which was tabled by the hon. Member for North-East Hertfordshire and his colleagues. They may feel that the issue has been tackled by Government amendment No. 203. If that is the case, it shows that the Committee can be of some use, which is something that I welcome. 
 Amendments Nos. 189 and 256 seek to probe the Government on the balance between council members, who are members of the council nominated by the regulatory councils, and the number of Government appointees, albeit that if Government amendment No. 203 is passed Government appointees will be mediated through the NHS Appointments Commission. Government amendment No. 203 provides reassurance for those who are worried that an automatic Government majority, if one includes those appointed by the devolved powers, goes too far in undermining the independence of the regulation of health care professions given the wide directional powers in clause 25. 
 In earlier sittings, I asked the Government whether they were certain that the protection of patients and the public could better be provided by professional self-regulation than by Government regulation, and the Minister indicated that that was the case. Although I understand that the idea of the council is to identify best practice and to promote the interests of patients and the public, it is still unclear whether that cannot be done with a council the majority of whose members are appointed by the councils. The members may not all be professionals but the councils should appoint the majority. For the council to be effective, it must have the confidence not only of the public and Parliament, but of the professions. If the status quo ante is a professional majority, or at least a majority appointed by the councils regulating the professions, the Government must show a need for that to change to a minority appointed by the councils. I hope that the Government will set out why they feel that that must be the case. 
 Amendment No. 226 seeks to ensure that some regulations that the Secretary of State may lay to provide for various functions are subject to positive resolution procedure. In earlier sittings I suggested to the hon. Member for North-East Hertfordshire that there were some regulations that it would not be appropriate to die in the ditch over. This type of amendment allows Opposition Members to make a stand because it is in these sensitive areas that positive scrutiny by both Houses of Parliament would be most useful. 
 Government amendment No. 205 and amendment No. 187, which has become a quasi-Government amendment, seek to reduce the Secretary of State's powers to give directions to employees. I suspect that those amendments will be widely welcomed, and I certainly welcome them.

Oliver Heald: I start by commenting on amendment No. 255, which was tabled by the hon. Gentleman. There is an argument that the council should be weighted to reflect the size of membership of particular professions. The hon. Gentleman has suggested the figure of three members for the Health Professions Council as a means of raising the argument, and I would be interested to hear the Minister's view.
 I have some concerns about the idea of three members for the Health Professions Council because, for example, the Nursing and Midwifery Council, which does not mention health visitors but includes them, represents three large professions that would be represented by one member. Many more people are employed in nursing, midwifery and health visiting than in all other health professions put together, which means that one would not achieve the calibration that one would want on the council. The Minister may have some thoughts on whether it is right for those three bodies to be represented by only one member. It is an odd suggestion that chiropractors should have the same number of council members as nurses, midwives and health visitors. 
 I wonder whether the Minister would be prepared to consider the issue between Committee and Report stages because he may have further thoughts on how the council might be more representative. In Europe, the Council of Ministers has a weighted voting system, but that sounds like proportional representation, with which I do not agree.

Andrew Murrison: Does my hon. Friend sympathise with the notion that given that much of the council's business will be connected with the medical profession—because doctors tend to be in the frame when it comes to disciplinary action—it is reasonable that there should be weighting towards the General Medical Council, given that we do not expect the Health Professions Council to throw up a great deal in terms of disciplinary action on issues that are in the public eye, such as the Bristol royal infirmary and Shipman cases?

Oliver Heald: Those are the two competing arguments with which the founders of the American constitution had to wrestle. They decided that the Senate should have one representative from each state—

Simon Burns: Two.

Oliver Heald: Two from each state. The House of Representatives has a population-weighted franchise. I am interested to see whether the Minister is prepared to consider the matter more fully.

Evan Harris: Let me pursue the point made by the hon. Member for Westbury because it has some merit. The new council will be set up to promote best practice and it will want to be influenced by the councils' experience. If there is equal representation and therefore equal input, a council representing a small number of people against whom there are few complaints—which would mean that that council had gathered little experience to add to the debate—would have equal weight to the General Medical Council, which has huge amounts of experience. Value will be added by ensuring that that experience is put in.

Oliver Heald: I accept that there may be some professions that have greater experience of criticism than others, and it is true that the GMC has faced much criticism about the way in which it deals with such matters. It is about to reform itself in a manner that most of us would regard as worth while, and it brings a great deal of knowledge and expertise to the council. Some other professions have little experience of criticism or complaints against them, presumably because they deal with issues and practices that are less likely to lead to litigation or serious injury.
 Ministers might want to give a little more thought to certain issues relating to the weighting of the council. The Society of Chiropodists and Podiatrists was right to point out in a letter to the Committee that it represents an important profession. As was noted during our discussion of the recent health professions order, chiropodists and podiatrists provide an early-warning system for diabetes. They do tremendously important work, and in the light of moves towards surgical procedures they are moving up the medical practice scale. Perhaps the balance of probability of their receiving criticism and complaints will alter as they undertake different work. Theirs is a serious point. The hon. Member for Oxford, West and Abingdon has tabled his amendment in that spirit, and I shall be interested to hear the Minister's response. 
 Hilary De Lyon, chief executive of the Society of Chiropodists and Podiatrists, is very anxious to ensure that this issue is properly aired, in part because the Health Professions Council will not establish a statutory professional advisory committee. Through such a committee, many issues relevant to the profession could be fully aired and decisions taken. Because the arrangement will be much more ad hoc than the society would like, the importance of the issue is heightened. 
 Under amendment No. 188, other members of the council would be appointed 
''on the recommendation of the NHS Appointments Commission''.
 As the Minister said, the statutory regulators made that proposal to protect the independence of the council when such appointments are made. In the light of the Government amendments, to which we shall come in a moment, and subject to the Minister's explanation of them, it would seem that the Government have responded positively to that proposal. I welcome that. It is good when an Opposition discover that a Government agree with them, and we would be delighted to learn that our suspicions are correct and the Minister is indeed of the same mind on this matter. 
 Under amendment No. 189, the number of members appointed by regulatory bodies would equal the number appointed by Ministers. That proposal, too, would ensure the council's independence, and the statutory regulators and the British Medical Association support it. The BMA has said that 
''it is important that the chairman . . . and the director will be appointed by the Council. However, there is a contradiction that needs to be resolved between the worthy aspiration of independence of the new body and the provision in Schedule 7 . . . that the Government appointees on the Council will have a majority of one.
The BMA therefore supports the regulatory bodies' call for equal membership between Government and regulatory body appointees.''
 Does the Minister concede that point, or will he at least give further thought to it between now and Report, given that we are in a constructive mode in respect of schedule 7? The independence of the council is vital. The amendment would not give regulatory body appointees a majority over Government appointees, but it would make them equal, and that would be useful. 
 The Liberal Democrat amendment would establish ''one more'' regulatory body appointee, but I would not go so far.

Evan Harris: I was saying that the current requirement for a professional majority in the regulation of health care professions ensures professional, rather than Government, self-regulation, with all its associated connotations. One need only look at South Africa to see where such regulation can lead. The Government should at least explain why they are moving away from the accepted practice of professional self-regulation. Is such a move a sign that it can never work in respect of the functions in clause 23, or have matters simply rolled out that way?

Oliver Heald: The hon. Gentleman is obviously entitled to hear the Minister's response. I am not saying that, because the Kennedy report has reached a particular conclusion, that is the end of the matter. Such things need to be argued through, but Professor Kennedy had a point when, in paragraph 75, on page 349, he said:
''The purpose of the system of regulation must be to assure the public of the competence of healthcare professionals and, when necessary, to protect them . . . An effective system of professional regulation . . . needs an independence from the professions and from government which allows it to act in the public interest.''
 The benefit of my proposal is just that: it offers a division between ministerial appointees and regulatory body appointees that would maintain an entirely equal balance between the Government and the professions. If one accepts the Government's argument that they want to be one up, matters will edge a particular way; if one accepts the argument that the professions should be one up, they will edge the other. On this occasion, Professor Kennedy is right: we should hold the ring and maintain an entirely equal position. 
 Perhaps the Government and, indeed, the hon. Member for Oxford, West and Abingdon will argue that such a balance would leave no one in charge. However, we do not want a body of two sides—Government appointees and regulators' appointees—but appointees who co-operate, work together and interact. Making the numbers equal would ensure such co-operation. 
 I look forward to hearing the Minister explain the Government amendments. As I understand it, Government amendment No. 203, which would enable a special health authority to appoint other members in lieu of the Secretary of State, refers to the NHS Appointments Commission. That amendment is welcome, as is Government amendment No. 204, which would reduce the Secretary of State's regulation-making power in paragraph 5(a) by deleting its reference to 
''the number, or limits on the number, of members who may be appointed''.
 To judge by Government amendment No. 205 and the Government's acceptance of amendment No. 187, they have conceded that the Secretary of State's direction-making power over the appointment of, and terms and conditions of the appointment of, staff should be removed. The removal of that power is vital if the council is to achieve independence. 
 However, we are still tempted to press the Government on the regulation-making power and equality of numbers, and I shall be interested to hear the Minister's views on amendment No. 226 and whether he is prepared to look again at amendment No. 189. It is clearly crucial that regulations be made in a spirit that will achieve independence for the council. The final protection is that the matter must be debated on the Floor of the House or in Committee, given the requirement for an affirmative order. If the negative procedure were used, it would not be so debated.

Richard Taylor: I was delighted to hear, when the Minister was talking about clause 23, that he wholeheartedly supports independence from the Government. I should like clarification on amendment No. 203, which seems to me to remove the necessity for amendment No. 188 and probably also for amendments Nos. 189 and 256, which are very much supported by the BMA, the GMC, the Royal College of Nursing and the Chartered Society of Physiotherapy.

Oliver Heald: I hope that the hon. Gentleman does not accept that amendment No. 203 would remove the need for amendment No. 189, which would provide for equality of numbers between ministerial and regulatory body appointments to the council. Surely that balance is important.

Richard Taylor: My understanding is that if the appointments are made by the independent appointments commission, which amendment No. 203 suggests will be the case, they will not be Government appointments to the same extent.

Oliver Heald: Yes, but the balance of the numbers would remain the same: one more appointment for the NHS commission. Does the hon. Gentleman not agree that it would be better to have equality between its appointments and those of the regulatory bodies?

Richard Taylor: I shall wait to hear the Minister's comments and hope that they clarify the position.

Evan Harris: Just before the hon. Gentleman finishes, I should like to check one thing with him. Amendment No. 203 provides for appointments to be made by the independent NHS Appointments Commission, and therefore more independently of the Government, but that does not necessarily deal with the issue of whether there should generally be a professional majority or equality in the council. That is a separate point. One does not have to have a suspicion of the Government over independent appointments—although it helps—to be concerned about the broader question of whether we are seeing the end of professional self-regulation as a result of the loss of that majority.

Richard Taylor: All that I am trying to address at the moment is independence from the Government. I believe that to be the most important aspect.

John Hutton: May I clear up one or two misunderstandings that have emerged during the discussion? They were highlighted in the contribution just made by the hon. Member for Oxford, West and Abingdon. This is absolutely not the end of professionally led self-regulation. I tried to make that very clear in my arguments on clause 23 and on why we need the UK council. The council will not supplant the role of the GMC or any other body in professionally led self-regulation in those fields.

Evan Harris: They are concerned about it.

John Hutton: I think that that point is, however, accepted by the GMC and the other bodies, who broadly support the establishment of the UK council. The GMC has expressed support for the principle of a lay majority on the council.

Evan Harris: I know that the Minister has only just started, but I must stress that if there were not broader concerns about powers in clause 25, I would have little disagreement with what he is saying. Perhaps I should have made it clearer that my concern about this matter is strongly linked with concern about the extent of the powers in clause 25. I do not want to stray too far down that route, but the Minister will need to reassure me about those.

John Hutton: I very much look forward to reassuring the hon. Gentleman about them later. He rightly says that that is a matter for a subsequent discussion, and I do not want to intrude into debates on clause 25 now. However, he is quite wrong to say that clause 25(2) creates a wide power of intervention. It absolutely does not. We have tried to narrow it down to what we regard as the essential minimum reserve power that the UK council will need to discharge the responsibilities that this House will, I hope, give it in that area.
 I accept the general argument that concerns expressed about clause 25 are connected to those expressed about schedule 7 and clause 23. I hope to address that later. I think, however, that the hon. Gentleman was wrong to describe clause 25 as allowing a wide power of intervention. We have made it very clear that it is a reserve power, to be used as a last resort. It is an essential tool to enable the council to do its job properly on our behalf. 
 The amendments cover a wide range of issues. Amendment No. 255 would give the Council for Professions Supplementary to Medicine, or its successor body the Health Professions Council, three seats rather than one on the Council for the Regulation of Health Care Professionals. We have already discussed why I would find that proposition difficult to accept. 
 There has been some misunderstanding about the nature of the representative role but, as the hon. Gentleman himself argued, we do not envisage that the representatives of the regulatory bodies who will serve on the UK council will represent individual professional groups. They will be there to draw to the council's attention the experience that they have of regulation within their professional areas. It has long been the case, in relation to the Council for Professions Supplementary to Medicine, that there is a uni-professional regulatory body. That council is wide-ranging in scale and remit. It covers 12 discrete professional areas and there has been consensus and support for a long time for the uni-professional regulatory body in the area of professions supplementary to medicine. To disturb and shake that up now would not be terribly helpful. 
 The hon. Gentleman was, however, right in saying that there is no perfect way to ensure representation. I accept that, but there is usually a right way and a wrong way. The right way might not be the path of 100 per cent. consensus, but this is a matter for judgment and the House—Ministers, and hon. Members on both sides—must ultimately reach a decision. If in saying that there is no perfect way forward the hon. Gentleman means that there will not be 100 per cent. consensus, I agree with him. However, the arrangements that we are proposing for professional representation on the council are closer to the spirit of Kennedy than the alternatives that we have had on offer today. I will return to that point, because I want to quote Professor Kennedy on it. 
 Amendment No. 188 would ensure that the Secretary of State appointed the seven English non-professionals on the council on the recommendation of the NHS Appointments Commission. It will not surprise the hon. Member for North-East Hertfordshire to learn that we have a problem with the amendment: not with what it seeks to do, but with the way in which it would achieve it. As he is aware, the NHS Appointments Commission is a creature of secondary legislation, brought into existence under, I think, section 8 of the National Health Act 1977. I might be wrong about that section, but it was set up under the power that that Act granted to establish special health authorities. In general terms, it is a mistake to refer in primary legislation to the creatures of secondary legislation. I am sure that the reasons for that will be apparent to the Committee. I cannot accept amendment No. 188, but I consider that amendment No. 203 addresses the hon. Gentleman's concerns. He is right in his characterisation of the purpose of my amendment. 
 Amendment No. 189 would give the council an equal balance between members appointed by the regulatory bodies and those representing public and health care providers. Amendment No. 256, tabled by the hon. Member for Oxford, West and Abingdon, would reverse that, and give a majority to the regulatory bodies. There is a polarity of views from Opposition Members on that point. If we study the Kennedy report carefully—I shall draw the Committee's attention to a comment in it in a moment—it should become clear why we have chosen the path that we have, rather than the alternatives on offer. 
 Government amendment No. 203 makes provision for the NHS Appointments Commission to appoint the English non-professional members of the council. It is our version of amendment No. 188. In a sense, I agree with the analysis offered by the hon. Member for Wyre Forest of the effect of amendment No. 203 on the other amendments tabled by the hon. Member for North-East Hertfordshire. I consider that it does negate those amendments. As I understood it, the hon. Member for North-East Hertfordshire was concerned about the appointment of seven members by the Secretary of State in England. Amendment No. 203 entirely removes that argument from his arsenal of invective against the Government's proposals because the Secretary of State will not make those appointments. The hon. Gentleman's concerns have been addressed by our suggestions.

Oliver Heald: The Minister is absolutely right that that amendment changes the circumstances, and it is very welcome. However, the issue remains of the balance between regulators and lay members. The Minister still needs to address the subject of equality and balance.

John Hutton: I intend to do so shortly. However, the hon. Gentleman's argument, as I recollect it, was constructed on the premise that there was a need for balance between the regulatory body members and the non-regulatory body members because of his concern about Government appointments. That element of his argument, which was rightly identified by the hon. Member for Wyre Forest, is shot down by amendment No. 203. I shall deal with his wider area of concern later.
 Government amendment No. 204 removes redundant words that give the impression that the Secretary of State can intervene by regulations to decide on the number of members of the council. We wanted to remove any uncertainty about that. 
 Government amendment No. 205 is purely technical and consequential on Government amendment No. 187. 
 Government amendment No. 187 is a wonderful thing. For the first time in my experience—your experience as a Minister, Miss Widdecombe, is much more extensive than mine—the Opposition had tabled an amendment that was exactly the same as the one that I wanted to table.

Simon Burns: Oh yeah?

John Hutton: Yes, it was. I can assure the hon. Gentleman of that.

Simon Burns: But did the Minister decide that it was the amendment that he wanted to table after he had seen our amendment, in all its wisdom?

John Hutton: I can honestly say to the hon. Gentleman—of course, everything that I say is honest—that I had not seen his amendment.

Simon Burns: I do not believe that. [Hon. Members: ''Oh!'']

Ann Widdecombe: Order.

John Hutton: I can give the hon. Gentleman my absolute, 100 per cent., personal assurance that I did not see his amendment until it was drawn to my attention by my officials when we were trying to table our amendment. Perhaps they had seen it earlier, but I had not, and I did not realise that it was an issue until that moment.
 The hon. Gentleman did the right thing in tabling amendment No. 187. It is the first time that I can remember a Minister adding his name to an Opposition amendment. In fact, I do not think that it has ever happened before. I am not inviting you to participate in the debate, Miss Widdecombe, because that would not be right, and I am quite glad that you are not doing so. The amendment, which we obviously support, deals with the appointment of employees and further reinforces our determination to confirm the independence of the new council. 
 Amendment No. 226 would require the regulations about the appointment of members provided for in paragraph 5 to be made by affirmative order. As I am sure that the hon. Member for North-East Hertfordshire has anticipated, I am unable to accept it. I shall explain why in a moment. 
 Amendment No. 188 would ensure that the seven English members of the council who are not appointed by the regulatory bodies arrived there by a process of recommendation from the NHS Appointments Commission followed by appointment by the Secretary of State. There is a problem with the amendment in that it refers directly to the NHS Appointments Commission, which was set up under secondary legislation. It is, as Government amendment No. 203 makes clear, a special health authority, and the primary legislation needs to reflect that reality. Amendment No. 203 is designed to achieve precisely the same effect as the amendment tabled by the hon. Member for North-East Hertfordshire. I hope that he is therefore reassured about our intentions. 
 I am afraid that I have to disagree with the intention underlying amendments Nos. 189 and 256.

Evan Harris: Amendment No. 203 states:
''The Secretary of State may direct a Special Health Authority''.
 Could not it have been drafted to say that the Secretary of State ''shall'' so direct, given that under amendment No. 188 the appointment would be made on the recommendation of the NHS Appointments Commission instead?

John Hutton: Let me make myself clear. The Secretary of State will delegate his powers of appointment to the special health authority, the NHS Appointments Commission. We chose the word ''may'' over ''shall'' to reflect the fact that appointments would be made by the NHS Appointments Commission on behalf of the Secretary of State, not by the Secretary of State himself. It is possible that another body could be set up to carry out a similar function, and if we used the word ''shall'' we could find ourselves locked into a pattern of appointing people in the same way as before. A degree of flexibility is therefore required.
 I hope that I am making it clear that using ''may'' instead of ''shall''—we always have these debates in Standing Committee, and I could probably refer the hon. Gentleman to a debate that we had six months ago—does not change the substance of the Government's intention to delegate the function to the NHS Appointments Commission. The possibility that a future Secretary of State or Minister might decide that a different body should exercise the function on his behalf necessitates some flexibility but does not detract from that intention.

Andrew Murrison: Will the Minister clarify that further? As I understand it, the purpose of the Government amendment is to get over the difficulty created by the reference to secondary legislation. I do not see why the word ''shall'' should not be used instead of ''may'', given that it would, as he said, firm up the Government's intention that the NHS Appointments Commission make such appointments. The hon. Member for Oxford, West and Abingdon made a good point.

John Hutton: I apologise to the hon. Gentleman if my explanation was clumsy and he was unable to follow it.
 At the moment, the only body that can make the appointments is the NHS Appointments Commission, but that could change in future if the Secretary of State decided that a different entity should do it. If the Bill says that it ''shall'' be done by the NHS Appointments Commission, difficulties will arise if we want to revisit that. Moreover, a wider problem stems from the fact that the legal basis of the NHS Appointments Commission is in secondary, not primary, legislation, so the Bill should not contain a direct reference to it. 
 The ''may'' is not designed to give the Secretary of State the option on whether to delegate the power, but to leave open the question of whom he delegates it to. That is the difference between ''may'' and ''shall'' in this context. I hope that that has resolved the issue for the hon. Gentleman.

Andrew Murrison: Would the Minister have been happy to accept amendment No. 188 were the NHS Appointments Commission to be contained in primary legislation? In other words, is this purely a technical issue to do with the place that it occupies in primary or secondary legislation? If not, I still do not understand his objection to substituting the word ''shall'' for ''may''.

John Hutton: It would certainly be easier to contemplate using the word ''shall'' in those circumstances, because the House would have established in primary legislation the legal framework for the appointment-making process to be located in a particular place. However, the House has not done that. The Secretary of State has used his powers under the 1977 Act to set up a special health authority to discharge those functions for him. Because that situation could easily change, it is best that we have a discretion as to who exercises the appointment-making function. That is what ''may'' rather than ''shall'' seeks to do. It does not seek to affect whether or not the Secretary of State delegates the function to the NHS Appointments Commission, because he will do that. The argument is partly about primary versus secondary legislation. That in turn affects the question of whom the Secretary of State can delegate the function to, which could change because it is not regulated by primary legislation.
 Amendments Nos. 189 and 256 are more problematic. Amendment No. 189 would replace a majority of one on the council for those representing the needs of the public and health care providers with an equality of voices between those groups and the appointees of the regulatory bodies. 
 Amendment No. 256, which was tabled by the hon. Member for Oxford, West and Abingdon, would go a significant step further by giving the regulatory bodies a majority of one. I fundamentally question that approach. A key function of the council is to promote the interests of patients and other members of the public. Professor Kennedy was very clear about that. He said that 
''it needs the widest involvement of professionals, of the principal employer and of the public. It cannot achieve its purpose if it is a system which is designed and operated solely by particular professionals for their professional peers. Nor can it achieve its purpose if it is solely a matter for employers within the NHS. An effective system of professional regulation must be owned collectively.''
 That is what we are trying to do, but, as we made clear during the debate on clause 23 stand part, with a strong emphasis on what the council's main purpose should be.

Evan Harris: Does the Minister accept that what he has just quoted—he accepted that he would necessarily quote selectively from such a bulky report, as we all have—referred to the system of regulation? That was the subject of his quote, not the council or even the council foreshadowed in the NHS plan. If it is read in context, it is a statement that the whole system of regulation needs to have the widest possible involvement. It might be thought to be slightly subverting the Kennedy report, as we all may be tempted to do, to imply that that is a direct response to amendment No. 109 or, particularly, to amendment No. 256.

John Hutton: With the greatest respect to the hon. Gentleman, I do not think that he is right. The UK council will be part of the regulatory firmament; it will not be separated from it. The point made by Professor Kennedy applies equally pertinently to the establishment of the UK council.

Oliver Heald: Does the Kennedy report refer anywhere to giving the council a majority of lay representatives? My recollection is that Kennedy was anxious throughout the report to make the point that the council should be collective, equal and at arm's length from regulators and Government.

John Hutton: The hon. Gentleman is right and there is no specific recommendation to the effect that the UK council should have a majority of one in the number of people who are not drawn from the regulatory bodies. We have looked at the spirit of the proposals in the report and laid our proposals before the Committee and the House to give effect to that. As I said in my opening comments, the Government believe that of all the alternatives on offer, the proposals in clause 23 are closest to the spirit of Professor Kennedy's report.

Oliver Heald: Will the Minister think about the matter over Christmas?

John Hutton: I have many things to think about over Christmas. I shall be the Minister on duty in the Department of Health, so I shall be busy, but of course we are happy to reflect on the matter and take account of the hon. Gentleman's arguments. I assure him that we shall do so. However, I believe strongly that the proposals before the Committee enjoy the support of the regulatory bodies, particularly those concerning composition of the council, although I know that the BMA has a slightly different view. The regulatory bodies are supportive of our proposals for membership of the council and they probably enjoy the widest consensus and support that it is possible to imagine. I accept that others will have a different view and we have heard some of them today.

John Baron: To reinforce the point made by my hon. Friend the Member for North-East Hertfordshire, while the Minister is contemplating the matter over Christmas he should remember that the UK council exists ultimately to act in the interests of patients. A ministerial majority of one might be seen by many to create a conflict of interest. We are aiming to ensure that we deliver a health service that meets patients' requirements. The UK council will have an important role in meeting that objective, but its purpose will be to act in patients' interests. A ministerial majority of one contradicts that and I ask the Minster to consider that.

John Hutton: I agree that if that were the case, there would be a conflict, but it is not the case, because there will not be a ministerial majority of one. That is the point behind amendment No. 203, which I laboured at the beginning of my comments, but obviously not sufficiently for the hon. Gentleman to appreciate. There will not be a majority of ministerial appointments to the UK council. The hon. Gentleman has helpfully allowed me to make the point again and it has taken away one of the legs of the stool supporting his argument about equality of representation on the council. He made a fair point, but amendment No. 203 deals with it.

Evan Harris: I accept what the Minister said, but that was not my argument. I am a member of the GMC and the BMA, but I did not see the briefing from the BMA before the Minister's comments, so I was not speaking from it when I made my point. However, I note that the BMA supports the regulatory bodies' call for equal membership between Government and regulatory body appointees, which suggests that the regulatory bodies support amendment No. 189.
 If the Minister is basing his defence of a non-council-appointed majority and a Government-appointed system, albeit mediated through the NHS Appointments Commission, on the quotation from paragraph 75, that same argument could be used to remove the professional majority from all regulatory systems because the words are general and do not state—Professor Kennedy would have done so had he wanted to—that there should no longer be a professional majority or a majority appointed by the councils on such bodies.

John Hutton: I made the Government's position clear on the composition of the membership of the regulatory bodies during an earlier debate and I do not want to go round that track again. We believe in profession-led self-regulation and the UK council is not subtracting from that. We must look at the purpose and role of the council in relation to the clause that we have just agreed in which its principal function is stated to be promotion of the interests of patients and the public. We must ask ourselves who is best placed to perform that role and whether it is members of the regulatory bodies—I agree with the hon. Gentleman that they could be lay members—or members appointed to the council by the independent NHS Appointments Commission specifically to carry out that role. The question is simple and I think that the answer is obvious.
 Amendment No. 204 removes any suspicion that the Secretary of State could intervene to tell the council how many members it could have. Paragraph 4 of the schedule also puts that beyond doubt. The council will have one member from each regulatory body and the number of other members appointed by the NHS Appointments Commission and the devolved administrations should always be one greater than the total number of regulatory body members. For example, when the council begins its work it will have 19 members: nine representatives of the regulatory bodies, three representatives chosen by the devolved administrations and seven members appointed by the NHS Appointments Commission. 
 The purpose of amendment No. 187 is to remove any concern that the Secretary of State would interfere in the running of the council. It is important to put beyond doubt the fact that the council has sole authority over staff appointments and their terms and conditions. That is the purpose of the amendment. I tabled it with related amendments Nos. 203, 204 and 205 to meet the concern of the regulatory bodies about the appointment of members to the council. It seems that the Opposition have also been listening to those concerns and we have come to a happy convergence of opinion. 
 Amendment No. 205, with amendment No. 187, tidies up paragraph 10(1) to reflect the removal of paragraph 10(2) and (3) by amendment No. 187, with which we all agree. 
 Amendment No. 255 would give the Council for Professions Supplementary to Medicine and its successor bodies the three representative members for which the hon. Member for North-East Hertfordshire called and I have tried to explain why we cannot accept the amendment. 
 Finally, the point at issue in amendment No. 226 is that of the regulations governing the appointment of the members of the council—for example, what conditions need to be fulfilled for appointments to be made. Every public body has some sort of provision on such issues. Typical headings include disqualification for appointment because of bankruptcy or having a criminal record, and termination of tenure of office for persistent absence and so on. They also include issues concerning declaration of interest and provision for people to stand aside from proceedings in which they have an interest. 
 I do not want to over-egg the pudding, but all Governments regularly make such regulations by statutory instrument under the negative resolution procedure. I have not heard an argument today for adopting a different approach in relation to the Council for the Regulation of Health Care Professionals, but there is an argument—I do not want to place heavy emphasis on it—about inevitable delay if the affirmative resolution procedure is used. 
 The hon. Member for Oxford, West and Abingdon said that he might want to press his amendment to a vote and I understand that. I said during an earlier debate along similar lines that the issue is not one to die in the ditch for, but the hon. Gentleman apparently wants to do that. However, given the technical nature of the issues covered, I would query whether a convincing case could be made for the affirmative resolution procedure.

Oliver Heald: I shall reply to the Minister's comments one by one. It is welcome that the Minister has tabled amendment No. 203, which covers the ground of the appointment of lay members by the NHS Appointments Commission. I am prepared to accept his assurance that the intention is to delegate that responsibility to the commission, so amendment No. 188 has done its work because it has prompted a Government amendment.
 In respect of amendment No. 187, I am pleased that the Minister has agreed that the appointments of staff are not to be directed by the Government. That is also welcome. However, the thorny issue remaining is the equality of numbers in membership of the council between lay representative and regulatory bodies. The Minister usefully promised that, over Christmas, he would spend his time in Richmond house mulling over that—I hope that he gets a mince pie too. On that basis, I will not press the amendment, or seek a Division on any amendment today, but will, on Report, return to the question of equality of numbers on the commission and will wait to hear from the Minister before deciding whether to press for the regulation-making powers to be dealt with by the affirmative resolution procedure. Those two issues are linked.

Evan Harris: It is important to state that amendment No. 226 on the affirmative resolution procedure was ''more'' of an issue to die in a ditch for, rather than ''the'' issue. I hope that my remarks were clear because I would not want it to be thought that I had invested more in this amendment than in others that I consider to be more important. Secondary legislation is introduced on such a large scale that there is a need for increased scrutiny and it is appropriate for Opposition Members to probe the issues. Later, it will be interesting to see what happens to the amendment. Often, many issues relating to secondary legislation on the regulation of the health professions are dealt with before delegated legislation is introduced. That is important because the Government may not get it right the first time.
 I will not add greatly to the discussion about equality of numbers, which relates to amendments Nos. 189 and 256, or to what the hon. Member for North-East Hertfordshire said. I agreed with much of what he said and the way that he said it. The Government's difficulty in respect of the Kennedy report is also ours. Hon. Members have already said that we do not have to endorse the report simply because it exists. However good the report is, things can be read both ways. 
 I am reassured by the Minister's repetition of his view that the councils directly regulating the professions will continue to be a form of professional self-regulation. That is his strongest point; he need not pray in aid the paragraph that he quoted from the Kennedy report—he is an hon. Member and has given us an assurance. The part that he quoted stated: 
''It''—
 which I assumed to be the system of regulation— 
''cannot achieve its purpose if it is a system which is designed and operated solely by particular professionals''—
 not professions— 
''for their professional peers.''
 I do not think that when it was drafted it was expected that the report would be scrutinised in the way in which we scrutinise legislation, so it would be of only limited value to go into that in greater detail. The danger of extrapolating from those sorts of comments is that it might imply Government support for a wider change from the principle of professional self-regulation, as exemplified—we need not get too carried away about this—by the majority on those councils, because it is more than simply a numbers game. I look forward to rejoining this debate at later stages. 
 Finally, with regard to amendment No. 255, I am pleased that I was able to pre-empt some of the Minister's points, otherwise it might have sounded as if he was pointing them out to me for the first time. If there is a discussion in the council about an important matter that generally comes up only in relation to the regulation of the General Medical Council or the General Dental Council, the majority of members on the council will not have had direct experience of that issue. Therefore, the danger is that if policy is made by a body that has no experience in dealing with such matters, something will be lost in the formulation of that policy. To a certain extent that is one of the issues that amendment No. 255 opens up. As I accepted in my opening remarks, there is no perfect way, so I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Amendments made:— No. 203, in page 73, line 13, at end insert— 
''4A (1) The Secretary of State may direct a Special Health Authority to exercise his function of appointing members of the Council under paragraph 4(1) (e). 
 (2) If he does so, the 1977 Act has effect as if— 
 (a) the directions were directions of the Secretary of State under section 16D of that Act, and, accordingly, 
 (b) the function were exercisable by the Special Health Authority under section 16D.''.
 No. 204, in page 73, line 16, leave out from ''including'' to ''any'' in line 17. 
 No. 205, in page 74, line 6, leave out ''Subject to sub-paragraphs (2) and (3),''. 
 No. 187, in page 74, leave out lines 9 to 13.—[Mr. Hutton.]

Oliver Heald: I beg to move amendment No. 227, in page 74, leave out line 16.
 This is a probing amendment designed to raise the question of the extent to which it is proposed that work should be undertaken in house, or contracted out. Its effect would be to require all work to be contracted out, which I do not suppose the Government would wish to do, but we would like to know what work the Government envisage would be outsourced. Would it be investigative work or opinion research? Will the Minister also explain whether a regulatory body could be asked to help investigate another? 
 Page 74, line 16, states: 
''Delegation of functions 
 11 (1) The Council may arrange for the discharge of any of its functions by — 
 (a) a committee, sub-committee, member or employees of the Council, or 
 (b) any other person.''
 I have chosen to delete line 16, but I could equally have deleted line 17. What I really want to get at is what the Council—in the Government's view—will do in terms of the delegation of the discharge of its functions. What sort of work would ''any other person'' be expected to do?

John Hutton: I take it from the hon. Gentleman's remarks that this is essentially a probing amendment, and he is trying to extract from me an assessment of under what circumstances the powers of delegation would be exercised. Let me explain why I think we need this provision in the Bill in the first place. It is a pretty standard provision in relation to bodies of this kind, which allows the council to exercise its discretion as to what work it might want to delegate to others within the organisation and outside. It clearly allows the council to go about its business efficiently and effectively, taking advantage of that type of opportunity when it thinks it appropriate. We therefore want to give the council the powers, tools and opportunities to go about its business effectively that we would give to any similar body. It is for the council to decide if, when and how its powers are used, and I would not want to take that freedom away.
 The answer to the question put by the hon. Member for North-East Hertfordshire is that this is a matter for the council to decide. We have had a long argument about independence from the Government, and he is asking me to say when the council might want to exercise its discretion to delegate. Hello? We cannot join those arguments together and present them as a whole. The important point is for the council to have discretion as to when and under what circumstances it might want to exercise that power. It would be for the council to decide who, what, when and how such a power was exercised. ''Who?'' might include, for example, academic bodies with expertise in this area from which the council will want to commission pieces of research. 
 The issue of committees and sub-committees relates to the good management of the council. Many regulatory bodies have committees to which they delegate responsibilities and powers, and those are matters for the council to decide. I cannot give the hon. Gentleman anything more concrete than that, given that we expect the council to act at an arm's length distance from Ministers.

Oliver Heald: Will the Minister deal with two points of detail? First, would it be possible for the council to say to one of the bodies that it is regulating, for example the chiropractors: ''We should like you to help us investigate this complaint against the nurses''? In the case of the police, the use of one police force to investigate another has always been subject to criticism. I was wondering whether the provision would allow bodies to be used in that way. Secondly, will it be possible to use outside investigators such as private inquiry agents to assist in a complaint investigation?

John Hutton: The hon. Gentleman is describing fitness-to-practice issues, which are not within the council's remit because of clause 24(3). The council would not have the powers to investigate individual fitness-to-practice cases. [Interruption.] Under clause 26, the Secretary of State would have the opportunity to establish a scheme whereby the council could deal with maladministration complaints through regulations, and this issue might arise in that context. These are, however, matters for the council to determine.

Simon Burns: May I seek some information from the Minister? I notice that in schedule 7, paragraph 11(1)(b)—''any other person''—allows the council to commission work from outside bodies and individuals, which will, if one examines paragraph 11(2), have to be paid for. The Secretary of State will provide funding for the body, but would there be a problem if funding goes to the private sector to commission work, which does not necessarily come cheaply? The budget will presumably be fixed, not elastic. Does the Minister envisage the workings of the council's being hampered by its inability to commission an adequate amount of work from ''any other person'' because of its financial constraints?

John Hutton: There is no such thing as a free lunch. All public bodies must operate within the resources that have been allocated to them. Yes, it is not cheap to commission pieces of specialist work from private sector bodies, or indeed any bodies outside government. It is right—I wish that I had referred to this point when the hon. Member for Westbury asked about the council's costs—to draw the Committee's attention to our intention to fund the council through the Department of Health, which will not entail passing on costs to the GMC, the General Dental Council or the General Optical Council. The council will be funded centrally, and it must operate within its budget. The way in which it chooses to discharge its functions or delegate and commission outside work must be compatible with its budget. There is no blank cheque, but by the same token the council must be properly resourced so that it can go about its jobs effectively. Like all of us in our daily lives, it must balance what it would like with what it has to spend. The council will be properly resourced, but how it decides to use its resources will be its concern, which accords with the spirit of operating at arm's length from the Government.

Oliver Heald: It seems that clause 26, which the Minister mentioned, provides the council with an investigatory role. It will, for example, be making payments to persons in connection with investigations. It is right that such investigations are into administrative matters rather than fitness-to-practice issues. Given that people will be doing investigatory work, the amendment is designed to find out who could do that work and whether it is right that one of the regulatory bodies, such as the chiropractors, could be asked to investigate maladministration by, for example, the Nursing and Midwifery Council. Will outside inquiry agents be used? Alternatively, am I missing the point and something else is being thought of here?

John Hutton: With respect to the hon. Gentleman, he is asking me to put myself in the council's position and tell the Committee how it will delegate its powers to outside bodies, which is not a position that I want to occupy, and I therefore decline to give him an answer. The hypothetical situation of the council asking the chiropractors to investigate complaints about the nurses strikes me as slightly eccentric, and I am unsure whether there is sense or logic behind that proposition. In principle, these issues are a matter for the council, which will have the widest possible powers of delegation. That is compatible with the way in which other bodies have been set up in the past. If the hon. Gentleman would like a note explaining how, if at all, similar bodies have used these powers, I am happy to provide that for him.

Simon Burns: To return to my earlier intervention, will the Minister clarify his valid point that all of us, including the Government, the Department of Health and the council, must live within our means? On the question that I raised about ''any other person'', I have suddenly realised that the Secretary of State can make loans to the council. Does that not undermine the Minister's claim that the council will be stuck within strict limits for its finances? If it needs more money to commission outside work, it can presumably go the Secretary of State for a loan.

John Hutton: The hon. Gentleman must have unique access to non-repayable loans, and he must tell me where he gets them.

Ann Widdecombe: Order. Debates on finance will be better conducted under the next group of amendments. We are now on amendment No. 227. May I ask the Minister, and any other hon. Members who intervene, to direct themselves to that amendment?

John Hutton: I am very grateful for that definition. I was looking forward to discussing with the hon. Gentleman whether loans are repayable—of course they are—and whether they must be paid from existing budgets. However, we shall return to that point in a moment. I am grateful for your indulgence, Miss Widdecombe, and I shall not try your patience any longer. This would probably be a good time for me to sit down.

Oliver Heald: I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

Oliver Heald: I beg to move amendment No. 228, in page 74, line 30, leave out
'on such conditions (if any)'.

Ann Widdecombe: With this it will be convenient to discuss the following amendments: No. 229, in page 74, line 32, leave out sub-paragraph (2).
 No. 230, in page 74, line 37, leave out sub-paragraph (4). 
 No. 231, in page 74, line 41, leave out 'and (4)'. 
 No. 232, in page 75, line 1, leave out sub-paragraphs (7), (8) and (9).

Oliver Heald: The purpose of the amendment is to remove the power of the Secretary of State to attach conditions to the payments that he makes to the council. The amendment is probing. What is the purpose of the conditions that are referred to in the schedule? The amendment would make the council as independent and undirected by the Secretary of State as possible. I should be grateful if the Minister would explain exactly what conditions he has in mind in relation to money for the council.
 Amendment No. 229 is another probing amendment and would delete paragraph 13(2) from the schedule. Why is it necessary for an appropriate authority, such as the National Assembly for Wales, to have the power to give money to the council, subject to conditions? The appropriate authorities are the National Assembly for Wales, Scottish Ministers and the Department of Health, Social Services and Public Safety in Northern Ireland. 
 Amendments Nos. 230 and 231 would delete paragraph 13(4), which relates to loans that may be determined by the various authorities; the amendments are directed at the conditional nature of the loans. Amendment No. 232 deletes sub-paragraphs (7), (8) and (9). Sub-paragraph (7) gives the Secretary of State the power to give directions as to the applications of funds, (8) gives the appropriate authority the power to give directions as to the application of funds and (9) requires the council to comply with those directions. 
 Do such conditions simply relate to the repayment of money and the way in which the Bill broadly applies so as to ensure no impropriety, or are they a direction that may have an impact on the council's independence? I am interested to hear what the Minister has in mind in respect of conditionality.

Simon Burns: May I return to my earlier intervention on the Minister on the previous amendment? It now seems to be a more appropriate time and I should like more information from the Minister about the loans.
 Before the Minister was rightly stopped by you, Miss Widdecombe, he was about to give us an elementary economics lesson on the fact that borrowed money must be repaid. I understand that, but if one borrows money, one normally repays it gradually in relatively small amounts each month, or according to whatever the terms and conditions happen to be. Some loans are made on the condition that there is no need to start repaying them for a significant period. Given the creative accounting of this Government, one could anticipate a number of sleights of hand to lend money, which would not necessarily be repaid in the immediate future. That could help a body and would, in effect, increase its funding so that it could fulfil its duties more easily by, for example, commissioning work from outside persons or organisations. The provisions in this part of the schedule lay down the skeleton powers to make loans and set down the conditions for repayment. One condition, unless the Minister corrects me, could be that a loan does not have to be repaid, or that it could be repaid at a date very far in the future, until which point it would, in effect, be interest-free and non-repayable. Is that accurate or is there some way in which, in theory, that could not happen?

John Hutton: Perhaps I should explain what we are trying to do here, and what the effect of the amendments would be. I understand that some are probing, but I am not sure whether all of them are.

Oliver Heald: Yes, they all are.

John Hutton: The amendments would make it impossible for the devolved administrations to make any payments or loans to the council. It is, of course, a UK council, and provision for that must be in the schedule. Amendment No. 231 is a consequential amendment following on from amendment No. 230, which, with amendment No. 228, would prevent the Secretary of State from placing any conditions on the use of those funds.
 The hon. Gentleman has asked me various questions, but I think that he essentially wants to know why such powers should be included in the Bill. We have been mindful throughout the debate, in preparing the Bill and in tabling amendments to it, of the need to meet the concerns of hon. Members and the regulatory bodies on the drawing of the line between the Secretary of State's proper accountability to this place for the use of public funds and the operational independence of the UK council so that it can get on and do its job without being subjected to unfair accusations that it is doing Ministers' bidding. 
 No gain or benefit would flow from the legislation if we became enmeshed in such arguments 18 months or two years down the track. The point of the UK council is to add value to the system of professionally led self-regulation, not to subtract from it, and as a direct result to ensure greater public confidence in how the system works. We would be pretty stupid if we engineered things so that we not only did not achieve that, but added to public concerns. We have tried throughout to ensure that the balance is redrawn in the right place. We want to deal with the concerns of the regulatory bodies, hon. Members and others, and to ensure that the independence of the UK council is properly enshrined in the Bill. 
 Paragraph 13 of the schedule is designed to enable the Secretary of State to set conditions to the exercise of his powers, if he chooses—he is not required to do so—to ensure, for example, that there is a proper audit trail and accountability in the council's use of public money. We are keen to deal with fraud. The Secretary of State might want to ensure that proper arrangements are in place in the council for dealing with such issues. In such a case the Secretary of State could, if he felt it necessary, set conditions relating to the powers to make grants and loans that he has. This is not, however, designed as some back-door way for the Secretary of State to have his fingertips on every decision of the UK council. That would be counterproductive. We have tried to ensure in the Bill that the Secretary of State can never be accused of so interfering with the council's work. 
 Paragraph 13 contains essential housekeeping or value-for-money provisions. They are commonly used, and were used extensively by the previous Conservative Administration in relation to other organisations to ensure proper public accountability. They do not go any further than that. 
 The hon. Member for West Chelmsford got very excited about loans. On this rare occasion, there was an element of absurdity in his argument. [Interruption.] I am afraid so. I say that with the greatest reluctance, but I thought that he was labouring a particular point about loans. Loans come in all shapes and sizes. The Department is not generally in favour of non-repayable loans, because they are not a sensible idea. The argument about creative accountancy was similar. I do not think that there is any suggestion that we might have to resort to non-repayable loans as a device to ensure that the UK council is properly resourced. We have other means of making sure that that is so. 
 In my experience as a Minister, all the loans that I have ever known of have involved repayment. If the hon. Gentleman, as I said earlier— 
 It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order. 
 Adjourned till this day at half-past Four o'clock.